Individual provider Active NPI

Ellen Rudzinski, NP

  • Adult Health Nurse Practitioner
  • Newton, MA
National Provider Identifier
1730236787
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
258448 Issued in MA
Practice address
83 Littlefield Rd
Newton, MA 02459-3010
Phone
(617) 928-1530
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 258448 MA Primary

Addresses

Primary practice location

83 Littlefield Rd
Newton, MA 02459-3010

Mailing address

9 Lilac Ter
Roslindale, MA 02131-3506
Phone (617) 323-4786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070113000036 MA Practitioner - Nurse Practitioner 0244230381 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
258448MAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Care of Boston Management Corporation CurrentSince Apr 1, 2010 Accepting new patients
Senior Healthcare Associates Inc PastSince May 28, 2003 Accepting new patients

Locations

93 Pond St
Sharon, MA 02067
Phone (781) 784-9212

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730236787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 LILAC TER",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021313506",
            "telephone_number": "617-323-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 LITTLEFIELD RD",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024593010",
            "telephone_number": "617-928-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDZINSKI",
        "first_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "258448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, MA

Sources for this page

Verify at the official NPI Registry.